Endocrine I Flashcards
1
Q
adenohypophysis vs neurohypophysis hormones
A
Adenohypophysis = GH, PRL, ACTH, TSH, gonadotropins
Neurohypophysis = ADH, oxytocin
2
Q
hormone that stimulates all cells for growth and repair
A
GH
3
Q
hormone that stimulates production of breast milk
A
prolactin (PRL)
4
Q
hormone that stimulates adrenal gland to produce cortisol
A
ACTH
5
Q
hormone that stimulates thyroid to produce thyroxine
A
TSH
6
Q
hormones that control reproductive functioning and sexual characteristics, stimulate ovaries to produce estrogen and progesterone/testes to produce testosterone and sperm
A
gonadotropins
7
Q
Neurohypophysis hormones are made in the _______ and transported into _______.
A
hypothalamus / neurosecretory granules
8
Q
hormone that controls the blood fluid and mineral levels in the body by affecting water retention by the kidneys
A
ADH (vasopressin)
9
Q
hormone responsible for contractions and breast milk production
A
oxytocin
10
Q
Name the pituitary gland abnormality: failure or decreased production of GH
A
pituitary dwarfism
11
Q
Name the pituitary gland abnormality: lack of response to GH
A
pituitary dwarfism
12
Q
Name the pituitary gland abnormality: short stature, small jaws and teeth
A
pituitary dwarfism
13
Q
treatment for pituitary dwarfism
A
human growth hormone replacement therapy
14
Q
benign neoplasm of the anterior pituitary
A
pituitary adenoma
15
Q
Name the pituitary gland abnormality: circumscribed mass in the sella turcica
A
pituitary adenoma
16
Q
Pituitary adenomas are more common in _____ between the ages _____.
A
men / 20-50
17
Q
Two types of pituitary adenomas:
A
macroadenoma
microadenoma
18
Q
Macroadenoma or microadenoma? large, functioning adenoma
A
macro
19
Q
Macroadenoma or microadenoma? associated with excess secretion of pituitary hormones
A
macro
20
Q
Macroadenoma or microadenoma? cause a mass effect due to the size of the lesion
A
macro
21
Q
Macroadenoma or microadenoma? may impinge on optic chiasm, leads to loss of vision
A
macro
22
Q
Macroadenoma or microadenoma? invasion of the cavernous sinuses (oculomotor palsies)
A
macro
23
Q
Macroadenoma or microadenoma? severe headaches
A
macro
24
Q
Macroadenoma or microadenoma? small, nonfunctioning adenoma
A
micro
25
Macoradenoma or microadenoma? found in 25% of adult autopsies
micro
26
caused by a GH secreting adenoma that releases hormones as people are growing, so before the closure of the epiphyseal plates
gigantism
27
generalized increase in the size of the body
gigantism
28
disproportionately long arms and legs
gigantism
29
treatment for gigantism
surgical removal of the adenoma
30
due to a pituitary adenoma secreting excess GH after growth is stopped
acromegaly
31
symptoms related to a space occupying mass in the brain: headaches, visual disturbances
acromegaly
32
Excess GH (acromegaly) causes:
- hypertension
- heart disease (CHF)
- arthritis
33
average of 9 years before death
acromegaly
34
Acromegaly
GH is produced after closure of the epiphyseal plates, leads to overgrowth of the bones of:
- membranous bones of the skull and jaw
| - small bones of the hands and feet
35
soft tissues affected by acromegaly
Coarse facial features
Nose is enlarged
Hypertrophy of the soft palate
36
mandibular prognathism (excessive growth of the jaw)
acromegaly
37
anterior open bite
acromegaly
38
may see spacing of the teeth develop
acromegaly
39
treatment for acromegaly
removal of the adenoma, radiation therapy
40
connection of the two lobes of the thyroid gland
isthmus
41
normal weight of the thyroid gland
10-30 grams
42
Describe the follicles of the thyroid gland:
- Surrounded by?
- Size?
- Vascular supply?
- Epithelium?
- Contain?
o Many small, round globules surrounded by epithelium
o Can vary somewhat in size
o Rich vascular supply
o Follicles are lined by thin, cuboidal epithelium
o Contain thyroglobulin (also called colloid)
43
follicular or parafollicular cells? stimulated by the release of TSH from the anterior pituitary
follicular
44
follicular or parafollicular cells? convert thyroglobulin into thyroid hormones
follicular cells
45
Thyroid hormones:
T4 (90%)
| T3
46
follicular or parafollicular cells? synthesize and secrete calcitonin
parafollicular
47
effects of calcitonin
- promotes the reabsorption of calcium by the skeletal system
- inhibits resorption of bone by the osteoclasts
48
6 effects of T3/T4:
1) Basal metabolism- increases BMR, body temp, appetite
2) Carbohydrate, lipid, and protein metabolism- promotes glucose catabolism, stimulates protein synthesis, increases lipolysis, enhances cholesterol excretion in bile
3) Reproductive- promotes normal female reproductive ability and lactation
4) Heart- promotes normal cardiac function
5) NS- normal neuronal development in fetus and infants, promotes normal neuronal function in adults, enhances effects of SNS
6) Musculoskeletal- promotes normal body growth and maturation of skeleton, promotes normal function and development of muscles
49
enlargement of the thyroid
goiter
50
Name the thyroid disorder: caused by impaired synthesis of thyroid hormone
thyroid goiter
51
Name the thyroid disorder: usually the result of dietary iodine deficiency
impaired synthesis of thyroid hormone due to a thyroid goiter
52
Diffuse or multinodular goiter? entire gland is enlarged, but not nodular
diffuse
53
Diffuse or multinodular goiter? endemic or sporadic
diffuse
54
Endemic or sporadic diffuse goiter? in parts of the world with low iodine
endemic
55
Endemic or sporadic diffuse goiter? 10% of the population have a goiter
endemic
56
Not enough iodine = not enough ____.
How does the body react?
How does the thyroid react?
What happens?
T4
Body releases more TSH, thyroid produces more thyroglobulin
Still can't make T4 because not enough iodine, so the thyroglobulin accumulates in the follicles (markedly enlarged!)
57
sporadic diffuse goiters occur in which gender
females
58
Endemic or sporadic diffuse goiter? puberty/young adults
sporadic
59
Endemic or sporadic diffuse goiter? ingestion of substance that interferes with hormone synthesis, hereditary defects in hormone synthesis
sporadic
60
Diffuse or multinodular goiter? develops from a long-standing diffuse goiter
multinodular
61
Diffuse or multinodular goiter? recurrent episodes of hyperplasia and involution leads to nodular changes
multinodular
62
causes the most extreme thyroid enlargement
multinodular goiter
63
Diffuse or multinodular goiter? diffusely enlarged thyroid gland, may double in size (still small), nodular
multinodular goiter
64
Diffuse or multinodular goiter? histology: follicles are irregularly enlarged, flattened epithelium consistent with inactivity
multinodular goiter
65
Name the thyroid disorder: clinical manifestation of thyroid hormone deficiency
hypothyroidism
66
Hypothyroidism is the clinical manifestation of thyroid hormone deficiency due to (3) things:
1) Defective synthesis of hormone (results in development of a goiter)
2) Inadequate functioning gland due to thyroiditis, surgery, or radioactive iodine therapy
3) Inadequate secretion of TSH by the pituitary
67
most common cause of hypothyroidism in iodine-sufficient areas of the world
autoimmune hypothyroidism
68
Hypothyroidism or hyperthyroidism? low T4/T3, elevated TSH
hypothyroidism
69
Symptoms of hypothyroidism in older kids/adults:
o Tired, sluggish, weight gain, sensitivity to cold
o Mental—difficulty concentrating, memory loss, slowed mentation
o Edema—facial skin, puffy eyelids, hands, feet, and tongue
o Heart—bradycardia, late stages if untreated (edematous, dilated heart, and pericardial effusions)
o Thinning hair, dry skin, constipation
70
another name for congenital hypothyroidism
crentinism
71
Congenital hypothyroidism is 2x more common in ______.
girls
72
Symptoms of congenital hypothyroidism:
Infants are sluggish, pale, and cold (95 F)
Impaired development of CNS will result in mental retardation if no treatment
Short stature due to defects in osseous maturation
Protruding tongue
Retained deciduous teeth, failure of permanent teeth to erupt
73
treatment for congenital hypothyroidism
Determine why hormone production is inadequate
| Thyroid replacement hormone
74
another name for hyperthyroidism
thyrotoxicosis
75
prolonged secretion of thyroid hormones T4 and T3
hyperthyroidism
76
symptoms reflect a hypermetabolic state
hyperthyroidism
77
Hyperthyroidism is more common in _____ 7:1.
women
78
85% of cases of hyperthyroidism
Graves disease
79
most frequent cause of hyperthyroidism is patients under 40
Graves disease
80
Name the thyroid disorder: autoimmune disorder causing a diffusely enlarged thyroid gland
Graves disease
81
What makes Graves disease an autoimmune disorder?
antibodies act as agonists by stimulating the TSH receptor and increasing hormone production
82
Clinical manifestations of Graves disease:
```
Diffusely enlarged thyroid gland
Exophthalmos—CT and muscle volume behind the eye increases
Nervousness, tremor
Irritability
Tachycardia, palpitations
Weight loss with increased appetite
Night sweats, diarrhea
Elevated T4 and T3
Depressed TSH
```
83
CT and muscle volume behind the eye increases
exophthalmos (associated with Graves disease)
*usually irreversible
84
Histopathology:
Overgrowth of glandular epithelium
Budding of small papillary fronds into what would normally be follicles
Absence of colloid
Graves disease
85
Treatment for Graves disease:
Beta blockers—for tachycardia, palpitations
Drugs that block hormone synthesis --> Propylthiouracil (PTU)—can cause hepatic failure long term
Radioactive iodine therapy I131—main side effect is hypothyroidism
Surgery
Exophthalmos is usually irreversible—cosmetic surgery
86
massive release of large amounts of thyroid hormone
thyroid storm
87
thyroid storm
Graves disease
88
Consequences of a thyroid storm:
leads to delirium, tachycardia, and elevated temperature
89
mortality rate of thyroid storm
20-40%
90
triggers of a thyroid storm
infection, psychological trauma, stress, epinephrine injection
91
autoimmune disease that inhibits normal thyroid gland function
Hashimoto thyroiditis
92
circulating autoantibodies against thyroglobulin
Hashimoto thyroiditis
93
CD8 cells can destroy follicular epithelial cells
Hashimoto thyroiditis
94
age/gender of Hashimoto thyroiditis
30-40
| women > men
95
thyroid shows diffuse, symmetrical enlargement
Hashimoto thyroiditis
96
patients become hypothyroid as disease progresses
Hashimoto thyroiditis
97
virtually unrecognizable as thyroid
Hashimoto thyroiditis
98
Histology:
• Virtually unrecognizable as thyroid
• Numerous collections of lymphocytes
• Formation of lymphoid follicles with germinal centers
• Remaining follicles are small
• Residual epithelial cells are very pink and packed with eosinophilic granules
Hashimoto thyroiditis
99
Hurthle cells- damaged, degenerating follicular epithelial cells
Hashimoto thyroiditis
100
1.5% of all cancers
thyroid carcinomas
101
2 types of thyroid carcinomas:
Papillary thyroid carcinoma
| Medullary thyroid carcinoma
102
Papillary or medullary thyroid carcinoma? most common thyroid carcinoma—85% of all cases
papillary
103
Papillary or medullary thyroid carcinoma? common in patients with exposure to ionizing radiation (atomic bomb survivors, nuclear accidents, diagnostic or therapeutic radiation to the neck)
papillary
104
Papillary or medullary thyroid carcinoma? often arise in females, 25-50
papillary
105
Papillary or medullary thyroid carcinoma? asymmetrical, painless enlargement of the thyroid gland
papillary
106
Papillary or medullary thyroid carcinoma? tumor mass may or may not appear to be encapsulated
papillary
107
Papillary or medullary thyroid carcinoma? good prognosis: 10-year survival > 95%
papillary
108
5-15% of all cases of papillary thyroid carcinomas
follicular carcinomas
109
Papillary or medullary thyroid carcinoma? can be multifocal because frequently invades lymphatics within thyroid
papillary
110
Papillary or medullary thyroid carcinoma? may see lymph node metastases in 1/4 if cases
papillary
111
Papillary or medullary thyroid carcinoma? fronds of epithelium within thin cores of fibrovascular tissue
papillary
112
Papillary or medullary thyroid carcinoma? fronds have a papillary pattern
papillary
113
All papillary neoplasms should be considered _______.
malignant
114
Papillary or medullary thyroid carcinoma? papillary growth and "empty" appearing nuclei
papillary
115
Papillary or medullary thyroid carcinoma? develop from the parafollicular "C" cells, excess secretion of calcitonin
medullary
116
Papillary or medullary thyroid carcinoma? ~5% of thyroid cancers, but very aggressive
medullary
117
Papillary or medullary thyroid carcinoma? 70% arise sporadically
medullary
118
Papillary or medullary thyroid carcinoma? familial form develops in patients with multiple endocrine neoplasia (MEN) type 2A or 2B
medullary
119
Patients with a familial form of medullary thyroid carcinoma may initially present with:
Multiple mucosal neuromas of the oral cavity and eyelids
You may be the first to diagnose it—before cancer
Patients receive prophylactic thyroidectomy
120
patients receive prophylactic thyroidectomy
MEN type 2A or 2B
